Combat Operational Stress Control Conference

Tuesday, 12 August 2008 || Wednesday, 13 August 2008 || Thursday, 14 August 2008

 

Creating Neural Pathways to Bravery

 

This (40 minute) presentation proposes that the impact of combat is determined by the event itself, the nervous system reactions to threat and danger, and the personal meaning/interpretation the individual gives to both the event and his/her reactions to it. Later recollections of the event, triggered by environmental stimuli, including conversation, include nervous system agitation and the meanings ascribed to the earlier experience. Traumatic memories are described as neural pathways and the suggestion is made that new pathways can be deliberately “etched” to better manage ptsd reactions. Recognition of bravery provides a counterbalance to the stress of extended combat experience and the adjustments which follow afterward. Several examples of Marine Medal of Honor recipients are introduced. A method by which images of personal bravery are incorporated into therapy efforts directed at reducing ptsd symptoms is provided. This method is based upon researched-established prolonged cognitive exposure techniques.

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The prevention of combat and operational stress injuries and illnesses such as posttraumatic stress disorder (PTSD) depends upon a comprehensive understanding of the risk factors that determine vulnerability, and the resilience factors that determine hardiness and recovery in Marines and sailors. The Marine Resilience Study, a collaborative research project sponsored by Headquarters, Marine Corps, the Naval Health Research Center, and the Department of Veterans Affairs has recently begun collecting prospective genetic, biological, psychological, psychiatric, and social data on ground combat Marines preparing to deploy to either Iraq or Afghanistan. The purpose of this workshop is to review the rationale for the Marine Resilience Study, present its early results, and describe how the study will be a useful tool for the Marine Corps and Navy in understanding and managing the combat and operational stress continuum.

 

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The 3d Marine Division is unique in that the 3d Marine Regiment - an infantry unit very active in OIF, is based in Hawaii, six thousand miles from the Division Command Element in Okinawa where all OSCAR personnel are located.. As battalions from 3d Marines engaged in repetitive heavy combat tours, demand for mental health services increased dramatically resulting in identification of gaps in mental health capacity, with a mounting backlog in access to care, and of mental health and traumatic brain injury (TBI)-related limited duty cases that were slow to be administratively resolved.   In response, the Division initiated a Table of Organization Change Request (TOCR) for a Regimental Psychiatrist and Psych Tech. While officially still in the approval process, stop-gap arrangements were made to place a Navy Psychiatrist to 3d Marines in October of 2007. The impact has been very positive, with vastly improved access to care, better coordination with other Hawaii-based military mental health and neuropsychiatric assets, and more efficient resolution of mental health and TBI-related limited duty cases. While there has been infusion of OSCAR capability, the complete establishment of this program will depend on completion of the TOCR and arrival of the Psychiatric Tech. We make the recommendations for a regimental-level OSCAR Psychiatrist and Psych Tech Marine Corps wide. 

 

 

The exceptional circumstances wrought by prolonged war and multiple deployments have greatly increased stress on Marines, Sailors, and their families. The rising incidence of documented PTSD and suicide-related events is evidence of this and requires aggressive mitigation. Management of Operational Stress Control for Marines, Sailors, and their Families is incumbent upon all levels of leadership, and it’s critical to reduce the stigma associated with mental illness and barriers to asking for help. To that end, MARADMIN 428/03 kicked off the OSCAR concept and stated that the program will be comprised of a fully integrated multi-disciplinary team including Staff Non-commissioned officers (SNCOs) in addition to mental health care professionals and Chaplains. The 3d Marine Division OSCAR program, having had success utilizing SNCOs at the Division Surgeon Office level, formally established Company level SNCOs OSCAR Reps as a vital and integral part of the OSCAR team; a hand-chosen, by-letter appointment collateral duty; incorporating special training, and empowered with counseling, teaching, referral, and administrative duties. Details of the program and experience to date will be discussed.      

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This is a presentation for all Marines/Sailors that have served in a combat zone. It provides education to the Marines, their commanders and leaders on symptoms a Marine/Sailor may suffer after a tour in combat. Medical problems that may become chronic issues affecting deploy ability and fitness and what to watch for now that they have returned to garrison. Behavior problems commands may encounter due to combat stress or PTSD and guidance on getting that Marine/Sailor the proper care and support from his unit.

 

The Evolution of the Deployment Health Center at Camp Pendleton 

 

NHCP DHC, 17-member team of multidisciplinary providers whose job is to assess and identify service members for potential psychological or medical issues related to deployments.  Over 10,000 surveys have been completed. The DHC has had numerous challenges:Computer Access, size of the Base (125 thousand acres), identifying Marines/Sailors needing to complete a survey, overcoming Stigma Ensuring Marines/Sailors get the help they need, and Standardizing Treatment and Tools. DHC mental health providers are strategically placed throughout the base in regimental aid stations, group aid stations, Wounded Warrior Battalion and the Brig affording multiple benefits: MH care close to their worksite, -Patients seen in a medical facility vice MH Clinic, Collegial relationships established between MH provider and GMO’s ensuring immediate referrals.

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Based on an article published by the presenter in the April 2008 edition of Military Medicine, Chaplain Howard presents in this workshop a comprehensive and dynamic model of collaborative treatment of mental health issues in a combat unit. The model demonstrates how the unit Chaplain and medical Officer can work together, in concert, to more effectively and efficiently treat mental health issues, both in combat and in garrison. Assumptions for the model are discussed in detail, as are clinical issues related to assessment, diagnosis, and treatment. Treatment concerns of several common mental health issues including combat stress injury and combat-related PTSD are presented. Potential advantages and disadvantages of collaborative care are also discussed through the use of short case studies and professional / personal experiences. This presentation is a must for Medical Officers, mental health professionals, and Chaplains alike.

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This workshop examines the most common effects of combat stress on the family members in active duty military. The approach is from the family systems perspective. The workshop identifies the presenting problems of families and active duty military for clinicians. The goal of the workshop is to assist the clinician in recognizing combat stress as the underlying problem when presented in the context of family dysfunction. The objective is to propose clinical approaches to combat stress in the family or marital dyad. In addition the workshop addresses methods to engage the couple or family and to work with the family member seeking services to reduce the impact on the family system.

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This workshop presents strategies used in III MEF for providing a collaborative approach to family and relationship wellness in the context of COSC during pre and post operational deployment cycles. Presenters provide examples of pre and post-deployment family wellness self-assessment, relationship skills-building, COSC education for family members, techniques for gaining family member participation and strategies for intervention in COSC impacted families.

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This presentation will provide a broad overview of the Military Child Education Coalition’s (MCEC) Living In the New Normal: Supporting Children Through Trauma and Loss (LINN) principles and how deployment-related stress, injuries, and illness in a parent can affect children. It will also discuss how families and caring adults can help children build the necessary resilience to handle these challenges by equipping them with the tools to bounce back from life’s storms and stressors. Examples of information, resources and references to aid in fostering individual and community support efforts will be furnished. The MCEC’s LINN efforts are predicated on the belief that children’s inherent attributes of courage and resiliency can be strengthened through deliberate encouragement.

 

 

Participants will learn that the main mission of “Give an Hour” is to provide a nationwide network of mental health providers to help close the gap in mental health services to vets returning from Iraq and Afghanistan, their family members and significant others. Offering supplementary services of 1 hour per week, per client for a minimum of one year ---most likely providers will stay with client as long as it takes-- All MH providers hold valid state licenses to practice. Services are offer to current war casualties, including spouses, children, parents, siblings. Presentation will include how to access help on basis of client's location, and provider's specialties.

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This workshop utilizes a case study to illustrate the symptoms and associated intra and interpersonal factors associated with the self-medicating use of sexually compulsive behavior following exposure to traumatic combat experience. Elements of assessment, diagnosis, and treatment are explored, particularly from a biopsychosocial and spiritual perspective. The importance of assessing and treating pre-existing trauma from childhood and other sources is presented as it relates to the potential development of sexually compulsive behaviors and subsequent treatment of combat stress injury and PTSD. The progressive and debilitating nature of addiction is examined, as well as the various ways that compulsive sexual behavior can negatively impact the individual, family, and military unit. This workshop equips mental health professionals, military leaders, and Chaplains with resources to more effectively recognize and treat the rapidly growing problem involving the use of sexually compulsive behavior as a means of self-medication following combat. 

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Moderator: Dr. Jeffrey E. Rhodes, D.Min., HQMC COSC Training Coordinator 

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The Marine Corps and Navy Combat and Operational Stress Continuum Model is a tool for military commanders and operational leaders at all levels to promote resiliency and recovery from stress reactions and injuries in service members and their families. Crucial to the success of leadership-driven combat and operational stress control (COSC), however, are high levels of competence and interdisciplinary cooperation among religious ministry, medical, and mental health professionals who advise and assist commanders in their use of the Continuum Model. This workshop reviews the very successful training delivered worldwide by the Professional Development Training Course (PDTC) of the Naval Chaplains School in FY-08 in collaboration with Navy Medicine and Headquarters, Marine Corps, and it previews the FY-09 PDTC, which will train chaplains, counselors, and medical and mental health professionals in promoting psychological health and resilience in families and family members, including spouses, parents, and children.

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CAPT Richard Westphal, NC, USN, BUMED 

 

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The Combat Operational Stress Workshop is an early intervention and prevention psycho-educational class held at Counseling Services Camp Pendleton. This skill-building workshop fits into the COSC Continuum Model Reacting Zone. The workshop educates and empowers Marines’ and Sailors’ to identify signs and symptoms of combat stress while teaching cognitive behavioral strategies and relaxation techniques to reduce and prevent progression of symptoms.

A simple and intensive 6-week model for the treatment of mild to moderate combat operational stress for active-duty Marines/Corpsmen incorporating the concepts of symptom management and mastery is offered at the DHC. It is designed to promote adaptive coping and resilience, enhancing a sense of self-efficacy, critical to the ideals of Marine Corps culture. The workshop provides a brief overview of the group model, and its potential to minimize stigma among those affected by COSRs. Its main goals are to achieve significant symptom reduction and behavioral change in a relatively short time and provide a framework for processing traumatic experiences in a group setting. The workshop promotes an understanding of the 3-part group trauma treatment model in a military environment and the rationale for its use. Data is limited and preliminary. In the past, the Mississippi Scale was used pre- and post-test; the PCL-M is expected to provide additional treatment efficacy. 

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HealthWalk has integrated four leading edge technologies to address the mind, body and emotional challenges associated with Combat Operational Stress and PTSD:

1. MindSoul Brain Technologies to identify and resolve the neuro-imbalances which can cause negative effects on the mind, emotions and body. 

2. Vital Hematology – live blood serum analysis to view biological activity and foreign activities in the blood - parasites, heavy metal, microplasma infections, fungus, inflammation, etc.

3. Functional Endocrinology – The endocrine system, is instrumental in regulating metabolism, growth and development, tissue functions and in moods, is analyzed via salvia testing and utilizing a sophisticated proprietary system to obtain a complete perspective of how to address the imbalances.

4. Neurotransmitter Profile Analysis – to provide a clear picture into the biological functioning of the brain and related body processes and then using MindSoul Brain Technology to resolve brain issues by supporting the bio-chemical functioning of the brain.

 

Caregivers may suffer cumulative and progressive declines in their stress tolerance under conditions in which they are constantly confronted with the consequences of battlefield trauma. Early and ongoing intervention is advantageous because it aborts the cumulative character of such decline in resilience. If a caregiver can be brought back to peak functional status on a routine basis, concern about burnout can be set aside. It is important for such an intervention to be regularly scheduled and mandatory. In this presentation, we will be discussing and demonstrating a method in which the brain is challenged to perform better in a way that is not tied to any presumed deficit. The technique is simply one of brain exercise, by analogy to physical fitness training. The focus is on positive qualities of functioning, as tracked by various measurements. The benefit lies in enhanced stress tolerance as much as in heightened performance.

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The most effective approach for mitigating and resolving the impacts of combat operational stress is one that involves a full deployment cycle education and training regime that equips the individual Marine to effectively self-regulate their responses and optimize performance when in the theater of operations. This presentation provides a new framework based in the neurophysiology of the human stress response and in performance models that support strength and resilience both on and off the battlefield. Through acquired understanding and the application of specific skill-sets, Marines can restore balance to the autonomic nervous system and maintain operational effectiveness throughout the deployment cycle. This approach also serves to normalize the experience of stress and remove stigma for those Marines who may experience adverse responses. This in turn facilitates access to support services and combat stress assets if needed and acts as a force multiplier for all other intervention strategies.

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Dr. Johannessen focuses his workshop on the emotional, psychological, & behavioral effects of witnessing violent trauma in childhood.By identifying & operationalizing 3 variables for analysis: empathy, intimacy, & autonomy, Dr. Johannessen provides insight into the trauma of witnessing violence as a child, the impact on the individual’s development and the potential problems in adulthood. His quantitative research study on 202 military veterans near Camp Lejeune, NC, showed statistical significance on all 3 variables: empathy, intimacy, and autonomy, supporting numerous studies on childhood violence and its negative impact on behavior. The unique challenges of the military family will be discussed as well as the programs used to assist these families and help decrease violence in the military.  

 

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Ms. Nance designed the Mental Toughness Concept enabling young Warriors understand the Marine Corps Values, which lead to success, are no different than the values adopted by highly successful, elite, professional athletes. She based the foundation of the concept on the Four Block Marine which requires Warriors be prepared to conduct business in a garrison environment, peacekeeping tasks, humanitarian efforts, and combat operations. They must be mentally tough to perform all of these tasks daily. Sustained operability in all areas demand becoming tough mentally, focused and confident they can do what the mission requires of them to achieve success.

 

 

Each research project officially endorsed and sponsored by HQMC COSC will be identified in an overview fashion. Main points of the project will be underscored. Participants will learn how these projects may benefit them in provision of care to Marines and Marine family members. Several of these projects involve new treatment models for assisting Marines and family members with addressing combat stress problems after return from deployment. Most studies include statistical analysis of the effectiveness of the program, and while not all of these data will be available during the presentations, attendees will learn how to gain access to accumulated and analyzed data at the completion of the project.

 

Men and women who participate in combat or who deploy to military operations in support of combat have always been affected by combat related experiences. Without a doubt, operational and combat stress significantly contributes to the loss of fighting force, and negatively impacts military readiness leading to suicide, multiple psychosocial problems and pre-normal end of military service.   Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that has been associated with combat stress.   PTSD also constitutes this study’s dependent variable. Specifically, this study includes Research Questions section, followed by Literature Review and Research Design sections. 

 

 

This workshop will demonstrate or describe a coordination of therapies which help eliminate the anxiety, depression, flashbacks, dreams, and recurrent images related to combat stress and Post-Traumatic Stress Disorder (PTSD). These therapies are currently being successfully at Parris Island Deployment Health Center.